Perinatal & Postpartum Therapy

You thought you were prepared. You read the books, took the classes, packed the hospital bag, downloaded the app. And then the baby came, and something happened that no class covered. Maybe it was a flood of feeling. Maybe it was a flatness where the feeling should be. Maybe a low hum of worry that won't turn off, or a sharp intrusive thought that scared you so badly you couldn't tell anyone. Maybe nothing acute — just a slow dawning that the woman you used to be isn't here anymore, and you don't know how to get her back.

This is what perinatal mental health work is for. And it's the heart of my practice.

What "perinatal" actually means

The perinatal period covers everything from before pregnancy through the first year (or longer) postpartum — the whole arc of becoming a parent. Mental health issues that show up in this window are called Perinatal Mood and Anxiety Disorders (PMADs). They're the most common complication of pregnancy and childbirth in the United States — more common than gestational diabetes, more common than preeclampsia. They affect about 1 in 5 birthing people. And about 75% of those affected never get treatment.

You are not unusual for needing this kind of support. You are unusual mostly in being willing to look for it.

What I help with

Postpartum depression

More than baby blues, less than a TV-special crisis. PPD can look like flat affect, irritability, exhaustion that sleep doesn't touch, guilt that you can't shake, a feeling that you're failing at this, or moments of wishing you could disappear. It can start any time in the first year postpartum (yes, the first year — not just the first six weeks).

Postpartum anxiety

The quieter sibling of PPD. Racing thoughts, checking the baby's breathing five times a night, scrolling worst-case-scenarios on the internet at 3 AM, physical tension that won't release, a sense that something terrible is about to happen at any moment. Postpartum anxiety is wildly underdiagnosed because it doesn't look "depressed" — it looks like a hyper-vigilant mom doing everything right.

Intrusive thoughts

A specific kind of postpartum experience that almost nobody warns you about. Sudden violent or disturbing images — what if I dropped the baby down the stairs, what if something terrible happened — that horrify you because they horrify you. Intrusive thoughts are not predictions and they are not desires. They are anxiety in a particular costume. They are treatable. You are not dangerous, and you are not alone.

Birth trauma

When the birth itself was traumatic — an emergency C-section, an unplanned NICU stay, a birth where you didn't feel heard, a medical event that scared you — the body remembers it whether you talk about it or not. Birth trauma can show up as flashbacks, avoidance, hypervigilance, or a quiet refusal to think about it that ends up costing you energy every day. Trauma-focused therapy helps.

Pregnancy and TTC mental health

Pregnancy is supposed to be the happy part, but for many women, it's the start of anxiety, depression, or the resurfacing of older mental health patterns. Trying to conceive — the grief of negative tests, the loneliness of fertility treatments, the way it can quietly take over your relationship — is a season that benefits enormously from real therapeutic support.

Postpartum rage

The symptom nobody warns you about. A sudden hot anger at your partner, your baby, the person who left the dishwasher half-loaded. Rage is often the surface of postpartum anxiety, sleep deprivation, and unmet need. It's not who you are. It's a signal.

Identity grief

The woman who existed before this baby is not coming back unchanged. That's not a failure — that's the nature of the change. But the grief of the woman who's gone is real, and it deserves its own space. We make that space.

What therapy with me looks like for new moms

The reality is you have a baby (or two or three), you are exhausted, and you do not have time to drive across Roanoke for a therapy appointment. Most of my perinatal clients see me by telehealth — from the couch, from the car in the carpool line, from their bedroom while the baby sleeps. In-person at my Albemarle Avenue office is also an option if you'd rather get out of the house.

The first session is about you telling me what's going on, in whatever order it comes out. The next several sessions are usually skill-building — anxiety regulation, sleep hygiene that's realistic with a newborn, intrusive-thought work, communication with your partner about who does what — alongside the slower work of understanding why this season has hit you the way it has. We move at your pace.

When to reach out

The honest answer: now is fine. But if you want concrete markers:

• You've felt low, flat, or anxious for more than two weeks
• Sleep deprivation isn't fully explaining how you feel
• You're avoiding being alone with the baby
• You're scared of your own thoughts
• Your relationship with your partner has gotten harder since the baby arrived
• You're white-knuckling through every day
• Something just feels wrong, even if you can't name it

If you are having thoughts of harming yourself or your baby, please call or text 988 (the national crisis line) or PSI's HelpLine at 1-800-944-4773 (Text "HELP" to 800-944-4773 for English, 971-203-7773 for Spanish). Then come back here when you're ready, and we can talk about ongoing support.

Practical details

• Format: In-person at 221 Albemarle Avenue SW, Roanoke, or telehealth across Virginia
• Fee: $175 per session
• Insurance: Aetna, Anthem, BCBS, Optum, Oxford, UnitedHealthcare
• Consultation: Free 15-minute call before you commit to anything

Resources

• Postpartum Support International (PSI) — national nonprofit, 24/7 HelpLine, free support groups
• Postpartum Support Virginia — Virginia-specific resources and provider directory
• 988 — national mental health crisis line (call or text)